Hippocrates: The "Greek Miracle" in Medicine

I. Historical Context

The Hippocratic Corpus consists of some 60 medical treatises, the majority of them conventionally dated to the later decades of the Fifth Century B.C., or to the early decades of the Fourth; that is to say, at the culmination of the "Classical Period," the time when Pericles was leader of the Athenian democracy, when Ictinus was designing the Parthenon and the Apollo temple at Bassae and Phidias finishing his gold and ivory statues of Athene Parthenos for Ictinus' temple and of the seated Zeus for the temple at Olympia.

To the later Plato and to Aristotle, Hippocrates from the island of Cos was known as a famous physician, and subsequent tradition sets Hippocrates into the midst of the intellectual ferment at the end of the Fifth Century. Aulus Gellius, a Roman rhetorician of the Second Century A.D., puts it this way:

Then the great Peloponnesian War began in Greece, which Thucydides has handed down to memory . . .. During that period Sophocles, and later Euripides, were famous and renowned as tragic poets, Hippocrates as a physician, and as a philosopher, Democritus; Socrates the Athenian was younger than these, but was in part their contemporary. (Noctes AtticaeXVII.21, 16-18).

A variety of developments enabled Hippocratic writers to make medicine a full participant in the so-called "Revolution of Wisdoms" of the latter Fifth Century B.C. A favorite explanation has long been influence from Presocratic natural philosophers, for these predecessors and contemporaries did pioneer techniques for explaining phenomena in the natural world by means of mechanical processes, summoning analogies that enabled them to see with the eye of the mind what was hidden from their eyes. The sophists, too, were important, for those teachers of knowledge and rhetoric spread over the Greek world at approximately the same time as itinerant Hippocratic physicians. Sophists' training taught men how to mount a convincing argument; direct participation in political assemblies and the law courts gave citizens ample practice in distinguishing between the lesser and the better argument and in deciding what constituted adequate proof. Important also seems to be the development of the Hippocratics' medium, the written prose treatise. In contrast to the writing of poetry, written prose develops slowly in the Greek world; medical writers, historians, and writers of political and judicial speeches seize upon it at approximately the same moment, and in their hands written prose rapidly gains sophistication.

II. Formation of the Hippocratic Corpus

The figure of a concerned and conscientious physician attracted not only a host of apocryphal legends about his great deeds, but also the heterogeneous collection of early medical writings known as the Hippocratic Corpus. These treatises collected under Hippocrates' name in Hellenistic times, certainly in Alexandria by the middle of the Third Century B.C. Ancient scholar-physicians who worked on the treatises as glossators and commentators were bothered by their heterogeneity of styles and their contradictory contents, and they borrowed methods current in Homeric criticism to explain them. Some suggested that Hippocrates' life was prodigiously long (perhaps 109 years!) and that he wrote some treatises when young and others when old; others conjectured that instead of a single Hippocrates, there were seven, all members of the same family, writing the treatises over several generations.

The "best" treatises were judged to be compositions from the hand of "The Great Hippocrates, Father of Medicine" at the height of his intellectual powers. Galen, practicing medicine at Rome in the latter half of the Second Century A.D., is certain, for example, that Hippocrates himself wrote Epidemics I and III, but that his son Thessalus must have discovered among his father's papers after the old man's death Epidemics II, IV, and VI in the form of notes scribbled on skins and wax tablets. The son, Galen supposes, misunderstood his father's intentions, and although the lad expanded what he found, what he published remained, in Galen's view, "unfinished works-in-progress."

Contradictions of fact also bothered subsequent readers, and the earliest extant references to the Hippocratic Oath, from the First Century A.D., show that Scribonius Largus, a physician who accompanied the Emperor Claudius to Britain, and Soranus, a Greek physician who practiced at Rome, worried about the provision that forbids giving a woman an abortive pessary, especially when the Oath is juxtaposed to the fact that two writers of embryology in the Corpus (Fleshes and Nature of the Child) describe aborted fetuses six and seven days old and acknowledge that they witnessed or caused the abortions that produced the fetuses.

Neither Scribonius Largus nor Soranus is worried about the historical and scholarly issues regarding Hippocrates, but they do wonder about what the oath prescribes for their own practice of medicine in Rome of the Principate. Each decides that he can summon Hippocrates as authority on the use of abortives. Scribonius Largus does so to prohibit all abortions, citing another Hippocratic principle, namely that medicine is the art of healing, not harming. Soranus decides that the Oath prohibits only abortive pessaries and that other procedures are permitted when the life of the mother is in danger, and he adds that he would never prescribe an abortive to preserve a woman's youthful beauty or to conceal her adulteries.

III. The Corpus after Antiquity

The figure of Hippocrates as "Father of Medicine" remains a potent one in medical circles throughout antiquity and beyond, although he is increasingly viewed through Galen's lens, which pictures an Hippocrates who is very much like Galen himself. Galen's enthusiasm for certain texts in the Hippocratic Corpus was crucial to the continuing interest later physicians took in Hippocrates and his writings, and Hippocratic texts were copied in sufficient numbers to survive into Byzantine times and be reimported into the West during the Renaissance. Renaissance anatomists, such as Vesalius and Paré, pointed with scorn to mistaken deductions that Galen drew from his dissections on animals, and Galen's influence suffered as a result. By contrast, once the Corpus was translated into Latin early in the Sixteenth Century, the prestige of Hippocrates and his writings escalated throughout Europe, as physicians continued the practice, now more than a millennium and a half old, of combing the Corpus in search of precedents for the medicine they were themselves currently practicing.

Only in the Twentieth Century have historians of medicine come round to admitting that there is nothing to connect "Hippocrates," the famous physician from Cos mentioned by Plato and Aristotle, with any single medical treatise in our present Hippocratic Corpus. While the historians Herodotus and Thucydides announce their names--"Herodotus of Halicarnassus" and "Thucydides the Athenian" being the very first words of their histories--the medical writers of the Corpus are nameless. They mention place names in the case histories of the Epidemics, but the towns and villages named are where their patients lived, from Elis in the western Peloponnese to Thasos in the northern Aegean and Perinthus and Chalcedon along the northern coast of the Black Sea. From the Epidemics one gets the impression of itinerant physicians, working in fairly close contact with one another on the same and similar medical problems from strikingly similar points of view, but writing them up in distinctive narrative styles.

IV. The Hippocratic Physician

This picture of the ancient physician coincides with what we know about doctors from the Eighth to the Fifth Centuries B.C. in other sources. Already in Homer's Iliad Podaleiris and Machaon, sons of Asclepius, accompany the Greek armada to Troy, where they fight and heal. Machaon's skill draws the admiring remark that "a healer is worth many men in his ability / to cut out arrows and smear soothing medicaments on wounds" (Iliad XI.514-515). A nascent theory of bodily humors, such as we see fully developed in the Corpus, operates in the epics: balance is a sign of health, imbalance, a harbinger of disease. Cholê is both Achilles' anger and the inner juice his body has accumulated in excess ever since his days as a nursling at the breast.

Although medicine is an old technê, Hippocratics burst upon the medical scene of the later Fifth Century as full participants in the intellectual discussions and debates that mark the later Classical Period. They were agonistic in stance and concerned with self-conscious presentation of their medical technê and with its ability to guide the doctor in a logical movement from theory to practice; that is, from nosological cause of diseases and intellectual constructs for human physiology to the administration of proper curative remedies.

V. Hippocratic Medicine

In common with other intellectuals in the Greek city-states, Hippocratics are interested in ethnography and far-away places and peoples, in epidemic diseases and plagues, in the origins of man and embryology, and in valetudinarian dietetics. Like their contemporaries Euripides and Aristophanes, Hippocratics are quick to pounce upon causes and remedies that they consider irrational, and they too express their scorn for earlier ways of thinking. The writer of Sacred Disease criticizes "witch-docotrs, faith-healers, quacks and charlatans," whose etiology for epilepsy and sudden seizures invokes attacks from the gods and whose therapies consist of purifications, incantations, prohibition of baths, lying on goat-skins and eating goats' flesh (Sacred Disease 1-2). The writer of Diseases of Young Girls censures women who follow commands from Artemis' priests to dedicate costly garments to the goddess in the effort to cure madness in the premenarchic young girl.

Both medical writers ground their etiology for the diseases in blockage of inner vessels by a bodily humor; both consider sitting still and having your feet go to sleep an appropriate analogy for the numbness that extinguishes the senses in the diseases. Both base treatment on the evacuation of the noxious fluid from vital areas of the body: the epileptic is to take a phlemagogue to move excess phlegm gradually from his head so that its sudden descent into his body doesn't overwhelm his senses, and the young girl is to sleep with a man as soon as possible to remove the impediment at the mouth of her uterus, while pregnancy will bring her long-lasting cure by opening up her body so that her excess fluids can move about freely.

VI. The Hippocratics and "Rationalized" Medicine

Hippocratics find it important to absorb all human diseases within their medical technê, including the very difficult sicknesses of sudden seizures and premenarchic madness, and to this end they not only assign mechanical causes that interact with the anatomy and physiology they endorse, but they also employ therapies that reverse a diseased condition in accordance with the same mechanical principles. "Opposites cure opposites" is a deliberate intellectual stance in opposition to the "like cures like" of sympathetic magic. Hippocratics know how to speak the language of science, and they are certainly the first in the Western tradition to write medical science in a form that has survived to our time. They formulate questions that the West has continued to ask: What makes this person sick? Do women get sick in the same way as men?
We can object that neither a descent of phlegm from the head as an etiology for epilepsy, nor a fantasy membrane at the mouth of the uterus in the young girl, is an empirically visible phenomenon; and we can dismiss the medical content of their science. We cling, however, to some of their deontology and medical ethics, as summarized in the Hippocratic Oath.

What is important here is that these medical writers are asking not "Who causes this sickness?" but rather, "By what process does this sickness occur?" However imaginative their mechanistic explanations may be, Hippocratics can defend them with arguments that appeal to process, not to a capricious or malevolent deity, and they can explain the therapies they prescribe in terms of the actions that their medicaments set in motion.